Refugee health
Women and children are particularly vulnerable
The main health risks facing refugees are created by a lack of simple human needs – clean water, food and shelter.
In the cramped, basic conditions of a refugee camp, disease gains a strong foothold and can spread quickly throughout the population.
Aid agencies particularly fear the spread of cholera, and epidemics of diseases such as measles, meningitis, tuberculosis and polio.
Refugees are also likely to have been traumatised by what they have seen.
As thousands flee Kosovo, the United Nations High Commissioner for Refugees is co-ordinating an effort to ensure disease does not make life any worse for the escaping hordes.
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What are the risks?
Population movement, poor sanitation, water contamination and the interrruption of public health programmes are the main reasons for the spread of disease after natural and humanitarian disasters.
Often displaced populations are forced to gather in confined spaces, further enabling the spread of epidemics, such as cholera, malaria and dengue fever.
Another problem is the number of injured people who need to be treated.
However, the World Health Organisation says the presence of dead bodies is not a major factor in the spread of communicable diseases.
Kosovo
An example of the health problems facing a refugee population is offered by the current situation in Kosovo.
Lyndall Sachs, a spokeswoman for the UNHCR, outlined the major health problems and the steps being taken to deal with them.
She told BBC News Online: “The main concern for us is that many of these people do not have proper accommodation and they are traumatised by what they’ve been through in this past year.
“The problems we were seeing before this ‘hot’ war came about were respiratory problems, some nutritional problems.
“The vulnerable groups – such as women, children and the elderly – always suffer these sorts of problems. Their health is always the first to go.
“With the huge numbers that have gone across into Albania the big concern for us is, of course, sanitation problems.”
There are fears other diseases may be on the way.
“Cholera is always a concern – wherever you’ve got large concentrations of people, diarrhoeal problems will manifest themselves very quickly.”
She said the UNHCR was taking a two-pronged approach to tackling this problem.
First, they are getting drinking water into place.
Second, they are trying spread the refugee population around Albania so the sanitation systems do not break down.
Cholera
The spread of cholera is one of the main dangers following a humanitarian disaster – whether natural or enforced.
Cholera is an acute infection of the gut which causes chronic diarrhoea and vomiting.
This can lead to severe dehydration and, in some extreme cases, death.
Cholera hit Rwandan refugees badly
However, most people who are infected by the bug do not become ill and 90% of those who do are only mildly or moderately ill.
Cholera is spread by contaminated water and food.
The bug is most deadly when it arrives unexpectedly because there are often no facilities for treatment or because people cannot get treatment in time.
Cholera can be effectively treated with oral rehydration salts and antibiotics.
Containing a cholera outbreak involves ensuring there are proper sanitation methods for disposing of sewage, an adequate drinking water supply and good food hygiene.
The only cholera vaccine that is widely available is less than 50% effective and only lasts for a period of up to six months.
There are two other vaccines which protect against one strain of cholera for a short period.
Emergency response to disasters
The UNHCR is co-ordinating the health efforts of all the agencies on the ground in the Balkans, including those of the World Health Organisation’s Emergency and Humanitarian Action division.
Set up in 1993, the EHA works with other UN agencies and national health ministries.
Its first task in an emergency is to conduct a rapid health assessment in the affected areas within 48 hours of a disaster.
It is then likely to set up:
An early epidemic warning system
Measures to control communicable diseases
A programme for repairing key hospitals and primary care agencies affected
Water and sanitation measures
Programmes for ensuring necessary medical supplies are available
Establishing such measures may mean an appeal to international donors for supplies – the WHO is running such an appeal for Yugoslavia.
However, the organisation says it does not want create a dependence on foreign aid “which may overkill the long-term efforts WHO has successfully invested in emergency preparedness in the region”.
The WHO policy is to work within the emergency measures set out in the country affected.